Medical Treatment
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Follow-upPeople with earache caused by ear infection should have follow-up care with their doctors to insure that the infection has completely gone away.
NOTE: Ear infections often will return if only partially treated. Do not stop the course of treatment even though symptoms are relieved. |
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Prevention Preventive measures can be very useful to decrease the frequency of otitis externa. On the other hand, otitis media is difficult to prevent. Avoid the risk factors outlined under Causes, if possible.
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Outlook
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MultimediaMedia file 1: Otitis
externa: The ear canal is red and swollen. Thick drainage is
coming from the ear. |
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Ear Infections
Is this topic for you?This topic covers infections of the middle ear. For information on outer ear infections, see the topic Ear Canal Problems (Swimmer's Ear). For information on inner ear infections, see the topic Labyrinthitis.
Ear Canal Problems
(Swimmer's Ear)
Swimmer's ear (otitis externa) is an inflammation and infection of the ear canal  .
It occurs when the protective film that covers the ear canal
(lipid layer) is removed. This causes the ear canal to look red
and swollen; it may be narrower than normal and is tender when
the outside of the ear is gently pulled up and back.Swimmer's ear may develop when water, sand, dirt, or other debris gets into the ear canal. Since it often occurs when excess water enters the ear canal, a common name for this inflammation is "swimmer's ear." If you have had swimmer's ear in the past, you have a higher risk of having it again. Exostoses are bony overgrowths in the ear canal. They are caused by repeated exposure to cold water and commonly occur in divers and surfers. Exostoses may not cause symptoms, or they may lead to ear infections and hearing loss, especially if they are big enough to block the ear canal. Other causes of inflammation or infection of the ear canal include:
What is a middle ear infection?
Most ear infections form in the middle ear. The eustachian tube carries fluid from the middle ear to the throat. Sometimes during a cold, the eustachian tube becomes swollen and fluid is trapped in the middle ear. Bacteria or viruses can grow in this fluid and form an ear infection The
middle ear |
What Is Otitis Media?Otitis media, sometimes referred to simply as a middle ear infection or inflammation, is the most common cause of earaches. Although this condition is a frequent cause of infant distress and is often associated with children, it can also affect adults. The infection in the middle ear (where tiny bones pick up vibrations from the eardrum and pass them along to the inner ear) very often accompanies a common cold, the flu, or another type of respiratory infection. This is because the middle ear is connected to the upper respiratory tract by a tiny channel known as a eustachian tube.
Most parents are frustratingly familiar with otitis media. Except for wellness baby visits, ear infections are the most common reason for trips to the pediatrician, accounting for approximately 30 million doctor visits a year in the U.S. Today, almost half of all antibiotic prescriptions written for children are for otitis media, and the cost of treating middle ear infections in the U.S. has been estimated at $2 billion a year. Untreated, otitis media can lead to more serious complications, including mastoiditis (a rare inflammation of a bone adjacent to the ear), hearing loss, perforation of the eardrum, meningitis, facial nerve paralysis, and possibly Meniere's disease. What Causes It? Cells in the middle ear make a fluid that, among other things, help keep out invading organisms. Normally, the fluid drains out through the eustachian tube and into the throat. But if the eustachian tube becomes swollen, the fluid can become trapped in the middle ear, forming a breeding ground for bacteria that can cause the area to become inflamed and infected. This tube lies in a more horizontal position and is shorter in children, which may put them at even greater risk of infection. To the doctor, the eardrum of an infected patient appears red and bulging. The most common cause of otitis media is an upper respiratory viral infection, such as a cold or the flu. These disorders can make the eustachian tube so swollen that middle ear fluid cannot drain. Allergies - to pollen, dust, animal dander, or food - can produce the same effect, as can smoke, fumes, and other environmental toxins. Bacteria can cause otitis media directly, but usually these organisms come on the heels of a viral infection or an allergic reaction, quickly finding their way into the warm, moist environment of the middle ear. Invading bacteria can wreak major havoc, turning inflammation into infection and provoking fevers. Among the bacteria most often found in infected middle ears are the same varieties responsible for many cases of sinusitis, pneumonia and other respiratory infections. (Note: Flu shots do not offer protection from otitis media.) Otitis media occurs in various degrees of severity. A single, isolated case is called acute otitis media. If the condition clears up but comes back as many as three times in a six-month period (or four times in a single year), it is known as recurrent otitis media. This usually indicates the eustachian tube isn't working right. If it continues for weeks without clearing up, it is called chronic otitis media. A fluid buildup in the ear without infection is termed serous otitis media. In recent years, scientists have identified the characteristics of people most likely to suffer recurrent middle ear infections: males; individuals with a family history of ear infections; babies who are bottle-fed (breastfed babies get fewer ear infections); children in day care centers; people living in households with tobacco smokers; and people with poor or damaged immune systems or chronic respiratory diseases such as cystic fibrosis and asthma. |
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What is otitis media? Otitis media is inflammation of the middle ear. Otitis media can be acute or chronic. Acute otitis media is usually of rapid onset and short duration. Acute otitis media typically causes fluid accumulation in the middle ear together with signs or symptoms of ear infection; a bulging eardrum usually accompanied by pain, or a perforated eardrum, often with drainage of purulent material (pus). Fever can be present. Chronic otitis media is a persistent inflammation of the middle ear, typically for a minimum of a month. This is in distinction to an acute ear infection (acute otitis media) that usually lasts only several weeks. Following an acute infection, fluid (an effusion) may remain behind the ear drum (tympanic membrane) for up to 3 months before resolving. Chronic otitis media may develop after a prolonged period of time with fluid (effusion) or negative pressure behind the eardrum (tympanic membrane). Chronic otitis media can cause ongoing damage to the middle ear and eardrum and there may be continuing drainage through a hole in the eardrum. Chronic otitis media often starts painlessly without fever. Ear pressure or popping can be persistent for months. Sometimes a subtle loss of hearing can be due to chronic otitis media. How common is acute otitis media? Otitis media is the most common diagnosis in sick children in the U.S. Young children, infants, and preschoolers are particularly prone. Almost every child has at least one bout of acute otitis media before the age of 6. Why do young children tend to have ear infections? The Eustachian tube is shorter and more horizontal in young children than in older children and adults. This allows easier entry into the middle ear for the microorganisms that cause infection and lead to otitis media. The Eustachian tube is a canal that runs from the middle ear to the pharynx (the throat). The function of the Eustachian tube is to protect, aerate and drain the middle ear (and mastoid). Occlusion of the Eustachian tube leads to the development of middle ear inflammation (otitis media). The Eustachian tube is also called the otopharyngeal tube (because it connects the ear to the pharynx) and the auditory tube (and in Latin, the tuba acustica, tuba auditiva, and tuba auditoria). The pharynx (throat) is subdivided into 3 parts: the upper part called the nasopharynx, the middle part called the oropharynx, and the lower part called the hypopharynx. The Eustachian tube opens into the nasopharynx. |
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How does the Eustachian tube change as a
child gets older?
The Eustachian tube measures only 17-18 mm and is horizontal at birth. As it grows to double that length, it grows to be at an incline of 45 degrees in adulthood so that the nasopharyngeal orifice (opening) in the adult is significantly below the tympanic orifice (the opening in the middle ear near the ear drum). The shorter length and the horizontality of the Eustachian tube in infancy protects the middle ear poorly, makes for poor drainage of fluid from the middle ear, and predisposes infants and young children to middle ear infection. The greater length and particularly the slope of the tube as it grows serves more effectively to protect, aerate and drain the middle ear. The Eustachian tube in the adult is opened by two muscles (the tensor palati and the levator palati) but the anatomy of children permits only one of these muscles (the tensor palati) to work.
Why do children with a
cleft palate tend to have ear infections?
What microorganisms cause otitis media?
What is the relationship between
bottle-feeding and otitis media?
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What are the risk factors for acute
otitis media?
Upper respiratory infections predispose to acute otitis media. Exposure to groups of children (as in child care centers) results in more frequent colds, and therefore more earaches. Exposure to air with irritants, such as tobacco smoke, also increases the chance of otitis media. Children with cleft palate or Down syndrome are prone to ear infections. Children who have episodes of acute otitis media before 6 months of age tend to have more ear infections later in childhood.
What are the symptoms of acute otitis media?
The buildup of pus within the middle ear causes pain and dampens the vibrations of the eardrum (so there is usually temporary hearing loss during the infection). Severe ear infections may cause the eardrum to rupture. The pus then drains from the middle ear into the ear canal. The hole in the eardrum from the rupture usually heals with medical treatment.
How is acute otitis media treated? Children who have recurring bouts of otitis media may have a an ear tube placed (tympanostomy tube) in the ear to permit fluid to drain from the middle ear. If a child has a bulging eardrum and is experiencing severe pain, a procedure to lance the eardrum (myringotomy) may be recommended to release the pus. The eardrum usually heals within a week. |
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What causes chronic otitis media? The Eustachian tube normally prevents the accumulation of fluid by allowing fluid to drain through the tube. Chronic otitis media develops over time, and often starts with a chronic middle ear effusion (fluid) that does not resolve. This persistent fluid will often become contaminated with bacteria, and the bacteria found in chronic otitis media are often different from those found in acute otitis media. Therefore, anything that disturbs the function of the Eustachian tube can lead to chronic otitis media. Eventually, the mucosal lining tissues of the middle ear reflect the ongoing inflammation by becoming swollen and edematous (an abnormal accumulation of fluid); and enzymes (digestion proteins) that are made in the chronic fluid begin to effect on the surrounding tissues.
What happens to the eardrum in chronic otitis media? When the eardrum collapses, it can attach to the other middle ear structures. It is frequently seen draped around the middle ear bones (ossicles) or the inner wall of the middle ear (promontory). This disrupts the conduction of sound through the middle ear, and will diminish hearing. Gradually, the enzymes from the infected fluid will cause scarring between the ossicles and the remaining middle ear structures. Weakening of the eardrum from adjacent infection can cause a hole to form.
What happens to the eardrum after a
hole develops in the eardrum? |
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How is chronic otitis
media treated? Initially, antibiotics may resolve the infection. If a tympanic membrane perforation is also present, topical antibiotic drops may be used. If eardrum or ossicle scarring has occurred, that will not be reversed with antibiotics alone. Surgery is often indicated to repair the tympanic membrane (eardrum), remove the infected tissue and scar from the middle ear and the mastoid bone.
What are the goals of
chronic otitis media surgery?
How is chronic otitis
media surgery performed? Serous otitis media is inflammation in the middle ear without infection. Typically, the Eustachian tube is not functioning and cannot ventilate the ear normally. As a result, fluid accumulates in the middle-ear. This can lead to a dullness or fullness within the ear along with diminished hearing. |
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What limitations are there on a
child with otitis media?
Otitis media is not contagious (although the initial cold that caused it may be). A child with otitis media can travel by airplane but, if the Eustachian tube is not working well, the pressure change as the plane descends may cause the child pain. It is best not to fly (or swim) with a draining ear. Otitis Media At A Glance
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EaracheIllustrations
Alternative names Otalgia; Pain - ear Definition An earache can be sharp, dull, or burning pain. The pain may be temporary or constant. Considerations Ear pain in children is often caused by a build-up of fluid and pressure behind the eardrum, in the area called the middle ear. The middle ear is connected to the nasal passages by a short narrow tube, the Eustachian tube. The Eustachian tube allows normal fluids to drain out of the middle ear, and helps keep the pressure in your ear equalized. A cold or allergy can block the Eustachian tube due to inflammation and the build-up of secretions. This is especially likely in small children, because their Eustachian tube is shorter and more horizontal. When the Eustachian tube closes, the normal flow of fluid from the middle ear is prevented. The fluid begins to accumulate, which can cause stuffiness, pain, hearing loss, and an ear infection. The symptoms of an ear infection may include fever, ear pain, fussiness, increased crying, and irritability. Many children will have temporary and minor hearing loss during and right after an ear infection. Permanent hearing loss is rare, but the risk increases the more infections a child has. Ear pain in a child or infant is not always from infection, however. Other causes include water from bathing, soap or shampoo retention, or ear canal irritation from cotton-tipped swabs. Ear pain in adults is less likely to be from an ear infection. What you perceive as ear pain may actually be coming from another location, such as your temporomandibular joint, your teeth, throat, or other location. This is called "referred" pain. Common Causes
Home Care
Ear pain caused by rapidly descending from high altitudes can be relieved by swallowing, chewing gum, or other methods. Allowing infants to suck on a bottle during descent can help. Call your health care provider if For children, call your child's doctor if:
What to expect at your health care provider's office The doctor will perform a physical examination, which may include examination of the ear, nose, mastoid (bony part behind the ear), and throat. Pain, tenderness, or redness of the mastoid often indicates a serious infection. During the examination, the doctor will ask questions about the ear pain, such as:
Because most ear infections improve within 24 hours of seeing a doctor, physicians are less likely to prescribe antibiotics immediately, often waiting to see if symptoms persist or progress. This strategy has been shown to reduce antibiotic usage. If antibiotics are prescribed, it is important to take ALL of the prescribed antibiotic on schedule. Ear tubes may be inserted for children who have persistent or recurring ear infections, to re-establish the proper functioning of the middle ear. Inserting ear tubes is a simple and effective surgical procedure. Prevention The following steps may help prevent earaches:
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What Is Otitis Media?Otitis media means inflammation of the middle ear. The inflammation occurs as a result of a middle ear infection. It can occur in one or both ears. Otitis media is the most frequent diagnosis recorded for children who visit physicians for illness. It is also the most common cause of hearing loss in children. Although otitis media is most common in young children, it also affects adults occasionally. It occurs most commonly in the winter and early spring months. Is Otitis Media Serious?Yes, it is serious because of the severe earache and hearing loss it can create. Hearing loss, especially in children, may impair learning capacity and even delay speech development. However, if it is treated promptly and effectively, hearing can almost always be restored to normal. Otitis media is also serious because the infection can spread to nearby structures in the head, especially the mastoid. Thus, it is very important to recognize the symptoms (see list) of otitis media and to get immediate attention from your doctor. How Does The Ear Work?
A healthy middle ear contains air at the same atmospheric pressure as outside of the ear, allowing free vibration. Air enters the middle ear through the narrow eustachian tube that connects the back of the nose to the ear. When you yawn and hear a pop, your eustachian tube has just sent a tiny air bubble to your middle ear to equalize the air pressure. What Causes Otitis Media?Blockage of the eustachian tube during a cold, allergy, or upper respiratory infection and the presence of bacteria or viruses lead to the accumulation of fluid (a build-up of pus and mucus) behind the eardrum. This is the infection called acute otitis media. The build up of pressurized pus in the middle ear causes earache, swelling, and redness. Since the eardrum cannot vibrate properly, you or your child may have hearing problems. Sometimes the eardrum ruptures, and pus drains out of the ear. But more commonly, the pus and mucus remain in the middle ear due to the swollen and inflamed eustachian tube. This is called middle ear effusion or serous otitis media. Often after the acute infection has passed, the effusion remains and becomes chronic, lasting for weeks, months, or even years. This condition makes one subject to frequent recurrences of the acute infection and may cause difficulty in hearing. What Are The Symptoms Of Otitus Media?In infants and toddlers look for:
In young children, adolescents, and adults look for:
Remember, without proper treatment, damage from an ear infection can cause chronic or permanent hearing loss.
What Will Happen At The Doctor’s Office?
During an examination, the doctor will use an instrument called an otoscope to assess the ear’s condition. With it, the doctor will perform an examination to check for redness in the ear and/or fluid behind the eardrum. With the gentle use of air pressure, the doctor can also see if the eardrum moves. If the eardrum doesn’t move and/or is red, an ear infection is probably present. Two other tests may be performed for more information. An audiogram tests if hearing loss has occurred by presenting tones at various pitches. A tympanogram measures the air pressure in the middle ear to see how well the eustachian tube is working and how well the eardrum can move. The Importance Of MedicationThe doctor may prescribe one or more medications. It is important that all the medication(s) be taken as directed and that any follow-up visits be kept. Often, antibiotics to fight the infection will make the earache go away rapidly, but the infection may need more time to clear up. So, be sure that the medication is taken for the full time your doctor has indicated. Other medications that your doctor may prescribe include an antihistamine (for allergies), a decongestant (especially with a cold), or both. Sometimes the doctor may recommend a medication to reduce fever and/or pain. Analgesic ear drops can ease the pain of an earache. Call your doctor if you have any questions about you or your child’s medication or if symptoms do not clear. What Other Treatment May Be Necessary?Most of the time, otitis media clears up with proper medication and home treatment. In many cases, however, further treatment may be recommended by your physician. An operation, called a myringotomy may be recommended. This involves a small surgical incision (opening) into the eardrum to promote drainage of fluid and to relieve pain. The incision heals within a few days with practically no scarring or injury to the eardrum. In fact, the surgical opening can heal so fast that it often closes before the infection and the fluid are gone. A ventilation tube can be placed in the incision, preventing fluid accumulation and thus improving hearing. The surgeon selects a ventilation tube for your child that will remain in place for as long as required for the middle ear infection to improve and for the eustachian tube to return to normal. This may require several weeks or months. During this time, you must keep water out of the ears because it could start an infection. Otherwise, the tube causes no trouble, and you will probably notice a remarkable improvement in hearing and a decrease in the frequency of ear infections. Otitis media may recur as a result of chronically infected adenoids and tonsils. If this becomes a problem, your doctor may recommend removal of one or both. This can be done at the same time as ventilation tubes are inserted. Allergies may also require treatment. So, Remember . . .Otitis media is generally not serious if it is promptly and properly treated. With the help of your physician, you and/or your child can feel and hear better very soon. Be sure to follow the treatment plan, and see your physician until he/she tells you that the condition is fully cured |
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